1 Resident Rights for Florida CNAs This course has been awarded one (1.0) contact hour. This course expires on November 28, 2015 Copyright 2005 by RN.com. All Rights Reserved. Reproduction and distribution of these materials are prohibited without the express written authorization of RN.com. First Published: November 28, 2005 Revised: November 26, 2008 Revised November 28, 2012
2 Acknowledgments RN.com acknowledges the valuable contributions of...nadine Salmon, MSN, BSN, IBCLC. Nadine is the Clinical Content Specialist for RN.com. She is a South African trained Registered Nurse, Midwife and International Board Certified Lactation Consultant. Nadine obtained an MSN at Grand Canyon University, with an emphasis on Nursing Leadership. Her clinical background is in Labor & Delivery and Postpartum nursing, and she has also worked in Medical Surgical Nursing and Home Health. Nadine has work experience in three countries, including the United States, the United Kingdom and South Africa. She worked for the international nurse division of American Mobile Healthcare, prior to joining the Education Team at RN.com. Nadine is a nurse planner for RN.com and is responsible for all clinical aspects of course development. She updates course content to current standards, and develops new course materials for RN.com. Disclaimer RN.com strives to keep its content fair and unbiased. The author(s), planning committee, and reviewers have no conflicts of interest in relation to this course. Conflict of Interest is defined as circumstances a conflict of interest that an individual may have, which could possibly affect Education content about products or services of a commercial interest with which he/she has a financial relationship. There is no commercial support being used for this course. Participants are advised that the accredited status of RN.com does not imply endorsement by the provider or ANCC of any commercial products mentioned in this course. There is no "off label" usage of drugs or products discussed in this course. You may find that both generic and trade names are used in courses produced by RN.com. The use of trade names does not indicate any preference of one trade named agent or company over another. Trade names are provided to enhance recognition of agents described in the course. Note: All dosages given are for adults unless otherwise stated. The information on medications contained in this course is not meant to be prescriptive or all-encompassing. You are encouraged to consult with physicians and pharmacists about all medication issues for your patients.
3 Purpose and Objectives The purpose of this course is to expand the CNA s awareness of long-term residents rights. This will prepare them to uphold these rights while giving care. After successful completion of this course, you will be able to: 1. List what rights patients have. 2. Describe the role of an ombudsman. 3. State where to find a description of rights. 4. Explain what dignified and respectful care is. 5. Describe the role and responsibilities of an ombudsman. 6. State the role of the CNA in protecting resident rights. Introduction Basic human rights are protected by law in the United States. People living in long-term care facilities such as nursing homes have these rights protected by state laws, too. These laws are specific for their situation. They uphold respect and dignity for all patients. Many of these patients are vulnerable because of failing health or advanced age. These people need protective rights to prevent mistreatment. The rights state clearly what is right and wrong in how residents are treated (Centers for Medicare & Medicaid Services, 2012). They describe respectful and dignified care. They make sure residents know what services are available for them. They allow residents to keep and manage their own personal money. They give residents control over their own medical care choices. Federal Rights The Federal Nursing Home Reform Act of 1987 requires every long-term state facility to display a list of resident rights. All facilities that participate in Medicare and Medicaid programs must meet federal residents' rights requirements. This makes it clear to everyone what to expect. A phone number must also be posted for contacting an advocate if there is a problem. The amendment law aims to: Improve overall quality of life for nursing home residents. Provide services and activities that maximize their health and well-being. Involve residents and their advocates in the running of their facilities. Allow advocates easy access to residents and their records so they can be of help.
4 True or False? A list of resident rights should be posted in every long term care facility. True! This is one of the requirements of the Nursing Home Reform Amendment.. Resident Rights Nursing home residents have patient rights and protections under the law. These rights usually include: Respect: Residents have the right to be treated with dignity and respect. Services and Fees: Residents must be informed in writing about services and fees before entering the nursing home. Money: Residents have the right to manage their own money or to choose someone else to do this for them. Privacy: Residents have the right to privacy, and to keep and use their personal belongings and property as long as it doesn't interfere with the rights, health, or safety of others. Medical Care: Residents have the right to be informed about their medical condition, medications, and to see their own doctor. They also have the right to refuse medications and treatments. (Medicare.gov, 2012) Florida s Resident Rights The state law includes all the rights protected under federal law. Sometimes the wording is different or more specific. Be familiar with the rights of residents in the state in which you practice. In Florida, the state law requires all nursing home residents to be entitled to the following basic rights: Be fully informed about available services. Have a copy of facility rules and regulations. Get reasonable accommodations for special living needs. Organize or take part in gatherings within the facility. Be notified ahead of time about changes in rooms or roommates. Know the rules about transfer or discharge from the facility. Be allowed an overnight visit away from the facility. Choose their personal physician. Receive skillful care from competent caregivers. Be fully informed about their medical conditions. Make their own decisions about care and treatments. Refuse medications or treatments, except in an emergency. Petition the court about institutionalization.
5 Florida s Resident Rights Florida residents also have the right to: Keep their own money separate from facility accounts. Spend their money as they want to. Be fully informed about Medicaid and Medicare issues. Be allowed privacy when wanted. Have all personal information kept confidential. Be free from physical or mental abuse. Have freedom to receive visitors, make phone calls, or use mail services. See reports of facility inspections. Complain and receive a response to the complaint. File a report of abuse. Use an ombudsman to advocate for them. An Ombudsman is a patient advocate who investigates complaint with nursing homes to improve the quality of life for residents. They are trained to resolve problems on behalf of the patient (Department of Health and Human Services, 2005). What Is An Ombudsman? Ombudsmen are advocates for residents of nursing homes and assisted living facilities. They provide information about how to find a facility and how to get quality care. They are also trained to resolve problems and assist residents with filing complaints. Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long-term care system. A Long-Term Care Ombudsman: Resolves complaints made by or for residents of long-term care facilities. Educates consumers and long-term care providers about residents' rights and good care practices. Promotes community involvement through volunteer opportunities. Provides information to the public on nursing homes and other long-term care facilities and services. Advocates for residents' rights and quality care in long-term care facilities. (National Ombudsman Resource Center [NORC], 2012).
6 Upholding Resident Rights Resident rights are designed to protect residents against abuse and neglect and ensure their citizenship (rights of all citizens). Many of these rights concern freedoms that patients should have. These are freedoms to do things, go places, say things, and have things. Other rights are about how caregivers treat residents while providing care. There are several ways in which you can uphold your patient s rights. Did You Know? In some states, residents have the right to refuse restraints. Be aware of the rights of residents in your state. Visit the Consumer Voice to access a list of state specific websites that will provide you with the information you need to know about the rights of residents in your state. Understand the Rules of Your Facility It is very important for you to be familiar with the policies and procedures of the facility in which you work. Know the scope of your practice and be sure that you understand which activities are acceptable for you to perform, and which procedures are beyond your scope of practice. Familiarize yourself with the group activities available at your facility, so that you can promote these activities and encourage your patient to join in. Remember to announce room changes and / or roommate changes ahead of time, when possible, to give your patient time to adjust. Change can be difficult for the elderly. It may trigger depression, anxiety or disorientation. Patients often worry about not getting their needs met. Reassure them that their needs will be met. Although their place in the nursing home may be permanent, they may need to be temporarily transferred to a hospital in a medical crisis. If there is any other reason to be transferred, they should be notified a month in advance. Advocating for Your Patients As a CNA, you have a responsibility to look after the rights of your patients, and act as an advocate (supporter) of your patient's rights. You can advocate for your patients by following procedures to safeguard them, such as hand washing and proper identification before treatments. You can also advocate for them by reporting any action or activity that violates your patients' rights. For example, if you have reason to believe that an early discharge will harm your patient's recovery, you should bring this to the attention of the Registered Nurse with whom you are working, or report it to your nursing supervisor. Similarly, if you observe a practice or procedure that you believe to be wrong, you can advocate for your patient by reporting it to your supervisor immediately.
7 Flexibility & Withholding Judgment As a patient advocate, it is also important to be flexible and withhold judgment about your patients' choices regarding their care. Patients have the right to chose their personal doctors and also have the right to refuse some parts of the treatments or care that is planned. You must respect this right while still looking out for the patient s safety. Document and report any changes in your patient s condition or how your assignment is carried out. Patients are in charge of deciding what care they wish to receive or refuse. Keeping Patients Informed As a patient advocate you have a responsibility to keep your patients informed at all times. Do not hold back information that patients need to make their choices. They have the right to know about their medical conditions and the treatments that can help them. The doctors and nurses will give them this information, but they may not understand it. If a patient asks you to explain something, use words they can understand. Report and document the questions and concerns that your patients talk about. Patients have a right to complain about the facility, the people in it, and the treatment they receive. They also have the right to get a response from their complaint. They may file a report of abuse. If they do, they are protected from lawsuits over it. The ombudsman can protect their rights. Patients have the right to refuse parts of their treatment. A. True (correct) B. False Promoting Safety & Comfort Many long-term facilities allow residents to furnish their own rooms. You can help patients adapt to new spaces and changing conditions. Allow your patients to feel safe and comfortable by rearrange objects for greater convenience and safety. Always do this with the patient s agreement. If you spot any faulty or dangerous equipment, talk with your supervisor about it. Treat Patients With Respect & Dignity Always use a kind and polite manner in speaking. Call people by the name they prefer, not a nickname you like to use. Allow your patients time to talk and share feelings. Encourage your patients to share their concerns with you.
8 Preserve the dignity of your patients' appearance at all times. Keep them clean and appropriately dressed. Be sensitive to privacy. This applies to body exposure, personal space, private conversations, treasured possessions and personal information. What you know about residents in your facility should never be shared with anyone outside your job. Types of Abuse Residents have the right to be free from abuse and neglect by anyone in the nursing home, including staff members, other residents, volunteers, family, friends, or any other individual. There are different kinds of abuse: Physical Abuse: Includes hitting, striking, pinching, slapping, shaking, pushing, grabbing, handling in a rough manner, or injuring someone in another way. It also includes prolonged, excessive, inappropriate, or unauthorized use of physical restraints or drugs used to control behavior. Verbal Abuse: Includes name calling, yelling, swearing, frightening, belittling, intimidating, or threatening someone. Sexual Abuse: Includes sexual contact, sexual harassment, sexual coercion, and sexual assault. There should never be sexual contact between a staff member and residents. Financial Abuse: Includes theft of property or money and misuse of personal funds, such as charging for items of service included in the daily rate. Emotional Abuse: Includes belittling, causing fear or shame, threatening to punish residents for their behavior, threat of eviction, or encouraging a resident to pay for favors or attention. Neglect: Includes being ignored or being treated with indifference, not receiving basic medical or personal care (such as assistance with personal hygiene, adequate food, liquids, shelter, and clothing) and protection from health and safety hazards. Isolation: Includes involuntary seclusion, being prevented from meeting with visitors, or not having privacy with regards to telephone calls or mail. If you believe that a resident is being abused, you should immediately tell your supervisor and encourage your patient to contact the ombudsman. The number for the local Ombudsman Program should be posted in the nursing home. (The California Department of Public Health, 2012).
9 Encountering Abuse There are many different forms of maltreatment or abuse that you might come across, including: Rough handling and assaults. Unnecessary use of restraints. Force-feeding. Withholding food or necessary care. Leaving someone in harm s way. Leaving someone stranded when they need help. Yelling and threatening. Ignoring someone. Unwanted sexual contact. Not letting someone spend their money. Using someone s money for things they don t want. As a CNA, it is your responsibility to report and document any of these forms of abuse that you may encounter. Report Maltreatment Patients in nursing homes are vulnerable to abuse and neglect. In many states such as Florida, long-term healthcare workers are required by law to report elder abuse. You do not have to be certain of the abuse, as investigators will check out your suspicions. Remember that you are immune from being sued for making a report. Also, your identity is kept confidential. Conclusion You are a significant person in the life of a long-term care resident. Now you know what rights your patients have. You can care for them in a way that meets their expectation to be treated with dignity. References Florida Department of Children & Families (2012). Mental Health Services, North Florida Evaluation and Treatment Center: Rights of Residents. Retrieved September 11, 2012 from: Medicare.gov (2012). Nursing homes: Resident rights. Retrieved November 23, 2005 and updated September 11, 2012 from: The California Department of Public Health (2012). Nursing Home Residents Rights. Retrieved September 11, 2012 from:
10 The National Long Term Care Ombudsman Resource Center [NORC], (2012). Resident Rights. Retrieved September 12, 2012 from: Copyright 2005, AMN Healthcare, Inc. At the time this course was constructed all URL's in the reference list were current and accessible. rn.com. is committed to providing healthcare professionals with the most up to date information available. Please Read: This publication is intended solely for the use of healthcare professionals taking this course, for credit, from RN.com. It is designed to assist healthcare professionals, including nurses, in addressing many issues associated with healthcare. The guidance provided in this publication is general in nature, and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Hospitals and facilities that use this publication agree to defend and indemnify, and shall hold RN.com, including its parent(s), subsidiaries, affiliates, officers/directors, and employees from liability resulting from the use of this publication. The contents of this publication may not be reproduced without written permission from RN.com.
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